腹腔镜治疗卵巢成熟畸胎瘤80例的临床体会

Clinical experience of laparoscopic treatment in 80 cases of mature ovarian teratoma

目的:探讨腹腔镜治疗卵巢成熟畸胎瘤的临床疗效。方法:2013年7月至2015年7月在我医院接受诊治的卵巢成熟畸胎瘤患者160例作为研究对象,按照随机数字表法分成A组(n=80)和B组(n=80),A组患者行电视腹腔镜手术治疗,B组患者行开腹手术治疗。记录所有患者本次手术时间、术中失血量、肛门排气时间、术后拔尿管时间、住院天数等围手术期指标;患者化学性腹膜炎、肉芽肿、复发率、月经异常、下腹痛等预后指标;酶联免疫吸附试验(ELISA)方法测定手术前、手术后1d、手术后5d血清IL-6的水平。结果:A组患者手术时间、术中失血量、肛门排气时间、术后拔尿管时间、住院天数等围手术期指标显著低于B组(P<0.05)。两组患者手术治疗后,A组患者出现化学性腹膜炎、下腹痛症状的患者明显低于B组(P<0.05)。治疗前两组患者IL-6水平无明显差异,术后1d,两组IL-6水平显著升高,但A组患者IL-6水平显著低于B组患者,差异有统计学意义(P<0.05);术后5d,A组IL-6降至术前水平,A组IL-6水平低于B组(P<0.05)。结论:腹腔镜治疗卵巢成熟畸胎瘤与开腹手术相比,具有手术时间短、出血少、恢复快、并发症少等优点,且对患者血清IL-6水平影响较小,可作为首选的治疗方法。

Objectives： To explore the clinical effect of laparoscopic treatment for mature ovarian teratoma. Methods： 160 cases of mature ovarian teratoma in our hospital from July 2013 to July 2015 were selected and ran- domly divided into group A （ n = 80） and group B （ n = 80） according to a random number table method. Patients in group A were treated with laparoscopy, and patients in group B were treated with laparotomy. The operation time, peri- operative bleeding, anus exhaust time, catheter removal time and hospitalization days between two groups were compared respectively. The number of patients with chemical peritonitis, granuloma, recurrence, abnormal menstruation and lower abdominal pain were analyzed respectively. Recurrence rate and pregnancy rate were ana- lyzed respectively. Serum IL -6 before operation and one day, five days after operation were measured by enzyme - linked immune sorbent assay （ELISA）. Results： The operation time, peri - operative bleeding, anus exhaust time, catheter removal time and hospitalization days in group A were lower than these of group B （ P 〈 0. 05 ）. The number of patients with chemical peritonitis and lower abdominal pain in group A was lower than that of group B （ P 〈 0. 05 ）. Serum IL - 6 levels in group A and group B before surgery had no significant difference （ P 〉 O. 05 ）. IL - 6 was increased on the 1st day postoperatively, and group A was obviously lower than group B （ P 〈 O. 05 ） ; on the fifth day postoperatively, IL- 6 in group A returned to preoperative level, which was obviously lower than that of group B （ P 〈 0. 05 ）. Conclusion： Compared with laparotomy, laparoscopy treatment has the following merits ： shorter operation time, less bleeding, faster recovery time, and less complications. Laparoscopy treatment has smal- ler influence on serum IL - 6 levels in patients, which can be used as the preferred method of treatment.